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Just as you can't judge a book by its cover, you can't judge the Affordable Care Act without knowing the history and current trends.

Gov. Rick Perry's comment that Medicaid is a failed federal program is just plain wrong. Medicaid, overall, has been a success since it began in 1965. The Medicaid expansion will save lives and reduce poverty; have little to no cost and save money; boost local economies and save jobs; build a stronger health care system for all Texans; and provide roughly 1.5 million uninsured Texans with health coverage.

About 70 percent of those who will benefit from the Affordable Care Act and Medicaid expansion are employed. Among Latinos, only 40 percent have employer-based insurance coverage.

So it's not surprising that in 2011, Latinos represented 61 percent of the state's 6.1 million uninsured. Uninsured rates among Latino children and adults are 19 percent and 39 percent, respectively, which is two and three times that of non-Latinos.

The negative impacts on uninsured families are observable everywhere in the state's county hospitals, indigent care programs, charity clinics and emergency rooms. The lack of adequate health care perpetuates cheap labor, lower education and high poverty rates, which are the primary contributors to preventable and premature deaths, chronic diseases and high health care costs. Uncompensated health care exceeds $5 billion annually. These costs are passed on to taxpayers and individuals with private insurance through higher premiums. Expanding Medicaid would cost far less — $3.1 billion over four years.

The political obstacles were so terrible that not even Texas HB 3791 could pass the legislative session. HB 3791 proposed that the state accept Affordable Care Act Medicaid funding only if it can provide vouchers to “certain” low-income groups, promote health saving accounts, and control in implementing its “unique” Texas solution to the uninsured problem. Both would help continue Texas' traditional path of selective, incremental, and limiting impact in reducing the uninsured rate.

The bill's framework and approach were weak and not supported by numerous studies, particularly for low-income populations.

While Medicaid has often separated and negatively labeled population groups, after 50 years of unsuccessful attempts to reform our inequitable and ineffective health care system, the Affordable Care Act was signed into law in April 2010, and determined to be constitutionally appropriate by the Supreme Court in June 2012.

The health care law is far from perfect, but it's a good start. Ongoing implementation will be challenging, and will take years to fully realize its intent for equalized, cost-effective health care. If our values truly reflect equality of opportunity, it will be achieved — in spite of an opposition determined to undermine its implementation through means that range from outright lies, fear-mongering, and political and legislative barriers such as limiting funding for major components of the law.

Metaphorically speaking, in Texas, it may take bulldozers and dynamite to implement the Medicaid expansion. But in Texas, we must take the bull (policymakers) by the horns with a stronger organized vote against the opposition to ensure Texans get the quality health care they deserve.